An alternative for mental health

There is nothing like an insane asylum for gently incubating death.

Antonin Artaud

Mental illness is a topic that raises infinite questions and misunderstandings. It is

a field that draws attention due to the history of myths built around that have
produced fear, prejudices, and misconceptions.
The phenomena byproduct that mental disorders show is visually captivating,
emotionally draining and very complex in its semiology -drawing interest but also
rejection.

With a growing ratio of people suffering from different mental conditions, from
mild to severe, pharmacological advances are prone to give absolute answers,
which translate into an over-medicalized society. Despite the fact that scientific
advances are widely welcome to reduce critical conditions significantly, the side
effects can also be greatly hindering regarding developing skills to overcome a
crisis or to find new ways of understanding the causes of the illnesses. While
pharmacology becomes more specialized for different types of ailments,
medicines don´t seem to cure them yet.
So thinking of alternatives becomes a priority, these must be directed towards
helping people become more aware, develop new skills, become more
independent and learn to understand their triggers.

Despite the vast amount of knowledge science has produced up-to-date, there
are still significant parcels of related knowledge that haven't been figured out. We
might say that the state-of-the-art of psychopathology and the brain is still far
away from giving us absolute answers.
There is also an increasing prevalence of mental illness throughout the
population that is helping raise awareness but also concerns, and it helps spread
inaccurate information.
Mental illness is extremely stigmatized and due to the way it is treated seems to
fix romanticized ideas such as the ones depicted in films and literature. Regular
ideas about mental illnesses are related to a series of noisy symptoms, people
banging walls with their heads, lost gazes in deteriorated faces and so forth. It is
certainly true that there are patients in critical conditions and the physiognomy
changes, but a mental illness is more than just a collection of incomprehensible
behaviors and strange gazes. Although sometimes precise, these images
associated with mental illness contribute to set around it a halo of fantasy,
morbosity, distance, and incommensurable difficulty.
Similar visions are rooted in a historical perspective in which mentally ill people
were thought to be aware of their acts and be willing to behave in such a
fashion. Common thoughts about it were, among others, that they were faking
these symptoms, trying to annoy people, not compromising to be adults or even
possessed by dark forces.This approach to the otherness was threatening
because of the little information available that could explain the causes of the
illness. The semiology was frightening because of its oddity and helped stigma to
keep on over the collective unconsciousness.
Due to this poor understanding about human behavior and emotions, a wide
variety of “strange” people would be confined to mental institutions, even people
who after years were not able to be diagnosed for psychiatric reasons.This led to
social exclusion, and because of the increasing rates of individuals under
multiple “strange” conditions, soon institutions started to lack professionals who
would look after them efficiently. Some ailments had to do more with the quality
of the care of another human being rather than the treatments available by the
time when it was still in research. Some would be administered in a large scale –
as it is why they were created for–and then realized how they never worked, and
they were even causes of death.
As hospitals were overcrowded, drugs were restricted, the food was insufficient,
and a sense of abandonment grew in patients, with worsening
consequences.While some confinements lasted years, some people were
abandoned by their families and had to make asylums their home.The iatrogenic
effect, which is the adverse consequences produced by medical intervention,
raised the question about the effectiveness of confinement, that was also
expensive and ethically suspicious.
Leaving harmed patients behind who had no family to go to and, most
importantly, having been treated only for the symptoms with the sake of making
them disappear, they left the illness itself untreated, which had to do with their
history of abuse, trauma, and personality disorders.In the meantime, the
pharmacological industry was delivering promising medicines to treat the
biochemical imbalance.
It is in this atmosphere that the anti-psychiatry movement – named years later
this way- started questioning the treatments and their effects, the healing
properties of the confinement, the psychiatric categories in which patients were
packed in, and mostly the outcomes of the pharmacological treatment.

Deinstitutionalization started as a subversive and radical approach in the 60´s,

the way its members
understood mental illness began to permeate various communities of
professionals that promoted a paradigm shift.
A new way of conceiving mental illness gave birth to an extensive stock of new
alternative treatments.
One of the most important perspectives of this approach was to consider the
patient as a subject rather than as a number that would be classified, categorized
and standardized.
This movement was characterized for questioning the conventional psychiatric
practices arguing that “mental illnesses” have a social origin rather than an
absolute biological determination. Theorists like Thomas Szasz, David Cooper,
and Robert Laing questioned the psychiatric practices so as the behavioral [ the
solution was in the commitment made by patients; the political praxis as a way to
demystify social conceptions of psyche illnesses and the dismantle of the
orthodox psychiatry]
( J. Vallejo 2001)
While in the United States, Tomas Szasz said that mental illness was a social
myth, in Italy, Franco Basaglia worked within the field of law to make sure that an
institutional reform was given.He stated: “the objective of our action should not
be the fight against mental illness, nor the schematic affirmation that it is
exclusively a byproduct of the society ( that would only mean that we are differing
the problem to an organized moment in which all needs would be satisfied). The
real fight should be directed towards the masquerading ideology that tends to
cover all fundamental contradiction turning it into a modality adapted to the
means of control that we progressively have; this means it has to be tailored to
be instrumentalized according to the desired aims”.
While theorizing in Italy and the US, there was Cooper and Laing in England
who built a real alternative to confinement. Kingsley Hall was a house where the
aim was creating a sense of community amongst the patients; they reduced the
differences between doctors, nurses, and patients leaving it to the latter the
whole organization of the house, the rules, and the community
assemblies. People were left to live with their symptoms, unmedicated,
supported by the group, with the possibility of expressing by art means their most
intimate feelings without shutting them down. Occupational therapy was born.
At the same time, In Argentina, a whole new treatment was developing.While
treating patients with addictions, Eduardo Kalina who was a psychiatrist and
psychoanalyst realized the high resistance they would have towards the
adherence to the treatment. He noted that despite the improvement shown in a
regular session they would relapse at the moment they would go back to their
daily life. The conditions to where they returned were precisely the ones that
triggered the difficulties that led them to the addiction in the first place.
Looking for alternatives, Kalina called a colleague and asked for help saying he
thought that if the treatment expanded in time, it would be harder for patients to
return to the curse of thought that brought them back to the addiction. He thought
that if he could offer patients a professional presence in their everyday lives to
sort out certain complex difficulties, he could help them come out of their
problems in a more efficient manner.
With this new approach to mental instability and its successful outcome, the
practice started to grow and spread out the country. Therapeutic
accompaniment appeared in the scene of emotional treatments.
In the meantime, in the midst of the antipsychiatry revolution, health policies
around the globe began to establish that patients should not be in confinement
for longer than needed and that they should, within a brief period, be able to
close mental asylums and make people return to their homes.
This situation was complicated because there were a lot of patients that had
already been forgotten and abandoned and there was no family to claim them or
accept them back. This caused a major problem for the governments to solve, so
they started looking for different ways to cope with the situation.
So this new treatment proved to be of great help to reintegrate people to regular
life by having someone to act as a bridge between the confinement and the
returning to social life. It helped them resettle.
Along time, this resource was generalized as an alternative for critical patients
that avoided the confinement while help them cope with others and with the
surroundings by developing social skills in a safe, accepting and open
environment.
With time, this intervention proved to be an effective method for helping patients
come out of their lethargic condition and rather take an active role in their well-
being, transformed patients from being passive agents of public policies, subject
to a poor understanding, mistreated, overdiagnosed, overmedicalized and
underheard to becoming active agents in their healing process, gaining control of
their decisions.It also encouraged patients to be more conscious about the skills
they were lacking of and, therefore, were able to acquire them within this
profound process of self-knowledge characterized by an active reflection on their
condition in order to find new ways of dealing with the accustomed dynamics.
This intervention model, while developed within the psychoanalysis tradition in
the Republic of the Argentina in the 60´s, soon started to produce its theoretical
corpus that keeps on expanding nowadays thanks to the practical work that
nurtures the elaboration of the theory.
It can be defined as a clinical dispositif based in working with
subjectivity; tailored according to the very specific conditions of each subject. It
helps people avoid isolation; promotes social contact, a continuation of regular
activities that give sense to people´s lives and It also restores the bond with
people and prevents them from aggravating.
One of the most important aspects of this kind of intervention is that it is based
on listening to other´s suffering and their personal dynamics with families and the
beloved ones that fail.When patients can freely communicate with someone
about what they perceive, despite how noisy or shameful it may be, they can
depressurize all those painful feelings and at the same time reorganize their
perceptions towards others.As they gain understanding, they are also more able
to empathize and acknowledge the difficulties that others also have.

While the clinician– in this case, the therapeutic accompaniment– spends

sustained periods of time with the patient, he will most likely attend various
crises. Being there to go through it with the patient, sets the conditions to
experiment in a sort of a trial and error scenery so the patient can get resources
to respond in future situations when the clinician will no longer be there.When
there is room for free expression, patients can reformulate their ideas of their
own and other's behavior and performance promoting change and better
relationships.
The success of this kind of treatment relies on various aspects that structure the
setting and the professional relationship.One is the integration of an
interdisciplinary team that looks after every patient: A psychiatrist, a
psychotherapist or psychoanalyst; a coordinator and therapeutic
accompaniments usually integrate it.If necessary, other clinicians are called to be
part of the team, such as neurologists, nutritionists, endocrinologists and
whoever else the patient needs.The linkage that the team produces within is one
of the most important aspects; It resembles a net that serves to uphold and
support the actions and strategies taken to make changes in a system (family).
Foucault´s (1977) definition of dispositif explains with accuracy this
entanglement.
“ I have said that the dispositif has an intrinsic strategic nature, which means that
it is due to the manipulation of the related forces either to develop it towards a
specific direction or to block it, stabilize or use it, etc. The dispositif is always
inserted in a game of power but also always linked to one of borders or
knowledge that is born from it but also conditions it.” (p.194)
To introduce a dispositif in a system means that all the relations and elements
that constitute it are subject to questioning, and the core of the problematic
arises. In most cases, the professional team reenacts those dynamics in almost
an automatic fashion, but the primary task is to understand it and to make the
movements needed to help detangle the situations that are supporting the illness.
The patient is not only the one that seeks help but the whole family.

This way of intervening in the family dynamic changes the positions assumed by
the members, it reconfigures the way they link to each other which in most cases
is through a pathological bonding were one of the members constitutes the
symptom.

Foucault again explains how the team constitutes and organizes its inner
dynamic:
"What I’m trying to pick out with this term (dispositive) is, firstly, a thoroughly
heterogeneous ensemble consisting of discourses, institutions, architectural
forms, regulatory decisions, laws, administrative measures, scientific statements,
philosophical, moral and philanthropic propositions–in short, the said as much as
the unsaid. Such are the elements of the apparatus. The apparatus itself is the
system of relations that can be established between these elements."

Deleuze has also produced notions of what a dispositif is, and exemplifies with
accuracy what we work with when we integrate a team to offer treatment for
chronic patients:
“ In the first place, it is a sort of a bundle, a multilinear whole. It is formed of lines
from different nature, and those lines do not encircle nor comprise systems that
would be homogeneous on its own (the object, the subject, the language), but
they follow different directions, they form processes that are in a constant
imbalance and those lines either get close or move away from each other.”

This blending in a transdisciplinarity mode is the key to tackling a complex

dynamic with different edges interacting at the same time, so if the team can
resemble in a certain way, the mode in which the family group works, it can offer
a more effective strategy.
Another aspect that makes this treatment an effective one is that must be
designed according to very specific traits that are related to every single patient.
For instance, in two different patients with the same diagnosis, the conditions in
which the illness is given and the features shown are not the same; so it must be
adapted to accomplish the effects pursued.
In the institutionalization scenario, some of the effects seen were that the
confinement was so traumatic that when patients came out to live their lives, the
treatment first had to focus on reducing these effects and then treat the illness
itself deepening the patient´s suffering due to what was intended to “cure” in
them in the first place. Some of the effects were confinement itself, lacking
social contact, reducing the possibility to by contacting with others using a trial
and error to acquire social skills, over-medicalization, etc. In contrast, the extent
to which this intervention strategy can have an impact is enormous because
patients can be with their accompaniments in hospitals (even if the family chose
a psychiatric institution), clinics, schools, different kinds of non-institutionalized
lessons, at the doctor, even make a holiday trip with them.

To mention one more aspect that makes this alternative treatment a highly
effective choice is that it works specifically to help patients maintain social
contact, it provides real time scenarios where they can still participate without the
sense of alienation that aggravates the illness. Through a secure environment
that is provided by the professional with his presence and active listening, the
patient can interact with others feeling supported even if a crisis occurs. It is
actually for those awkward moments patients struggle with, that the presence of
a therapeutic accompaniment is best because nothing can substitute the best
way of learning social skills than the experience approach. This way of learning
has proven to be the most accurate as it becomes significant.
So treatments for chronic patients might not cure, but they are more humanely
than extracting them from life to live in extremely artificial conditions. Moreover, it
preserves gregariousness, one of the most important aspects of the human
condition and one that serves specifically for a better and faster recovery.
Mental illness can be extremely segregating, and when it is confined it gives the
impression that it doesn’t exist or at least that the frequency of manifestation is
reduced. However, contemporary life conditions are producing even more
illnesses than before. As information is widely spread, more people get to identify
symptoms in themselves. This produces an increase in consciousness of these
ailments and also the proliferation of new and different treatments such as
therapeutic and pharmacological.
The perception of mental illness is also broadening, no longer having to do with
only extremely critic ailments but recognizing that those diseases that are
thought to be mild can also produce great harm in the long term –anxiety and
depression could be used as examples of this–.
Understanding that the illness has an intrinsic logic and meaning to the person
widens the comprehension of the problem and leads to different kinds of
possibilities for stabilization.
The kaleidoscopic nature of human psyche requires that more options are
available to treat different kinds of conditions, these should be able to integrate
different perspectives that can offer practical alternatives to not only control
symptoms but to help produce a better understanding of the underlying aspects

References

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1.htm

 Cooper. D. (1967) “Psiquiatría y Antipsiquiatría” Ed. Paidos.

 Foucault. M. “The confession of the Flesh” [online version]:

https://www.scribd.com/document/61060369/23718118-Foucault-
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http://www.lafuenterevista.com.ar/notas/5unaaproximalacomptera.htm

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concepción de su clínica".
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Ed.Masson. –translation done by me-